Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1437 | FL |
N | 222Z00000X | Podiatrist | 1437 | FL |
Y | 213E00000X | Podiatrist | P313 | CT |
Y | 222Z00000X | Podiatrist | P313 | CT |
N | 213ES0131X | Foot Surgery | P313 | CT |
NPI | 1184618480 |
---|---|
Provider Name | Dr. Richard Jeffrey Grayson |
First Address | Avon, CT 06001-3753 |
Second Address | Avon, CT 06001-3753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 27/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004050050 | (05) | CT |
T22065 | (02) |